Background: While acute severe asthma (ASA) is the leading cause of emergency department visits and the third cause of hospitalization in children younger than 18 years old, there is a lack of data regarding adult patients admitted in intensive care units (ICU) for ASA. We aimed to describe the evolutions in epidemiology, management, and outcomes of ASA in adult patients, over a period of twenty years in the Greater Paris area ICUs (CUB-Réa Database).
Methods: Demographics, severity and supportive treatments were collected from the CUB-Réa Database. The primary endpoint was the prevalence of ASA by periods of 5 years. The secondary endpoints were in-ICU survival, in-hospital survival, use of mechanical ventilation including non-invasive and invasive and catecholamine. Multivariate analysis was performed to assess correlating factors of ICU Mortality.
Results: Of the 475 357 ICU admissions from January 1997 to January 2016, 7049 were admitted for ASA with a decreasing prevalence over time, respectively 2.8%, 1.7%, 1.1%, and 1.1% of total ICU admissions (p <0.001). The median age was 46 years old [IQR: 25%-75%: 32-59], 3906 (55%) were female, the median SAPS II was 20 [IQR: 13-28], and 1501 (21%) had mechanical ventilation. Over time, age, the SAPSII and the Charlson Comorbidity Index tended to increase. The use of invasive and non-invasive mechanical ventilation increased (p < 0.001), whereas the use of catecholamine decreased (p <0.001). The in-ICU survival rate improved from 97% to 99% (p=0.008). In the multivariate analysis, factors associated with in-ICU mortality were SAPSII (p < 0.001), renal replacement therapy (p < 0.001), catecholamine (p < 0.001), cardiac arrest (p < 0.001), pneumothorax (p < 0.001), ARDS (p < 0.001), sepsis (p < 0.001) and IMV (p < 0.001).
Conclusion: ICU admission for ASA remains uncommon and decreases over time. Despite an increasing severity of patients and the use of mechanical ventilation, the use of catecholamine decreases with high in-ICU survival rate which could be related to a better management of mechanical ventilation.